Objective This study aims to evaluate the diagnostic efficacy of multi-slice spiral CT in early lung cancer and provide evidence for clinical differentiation. Methods A retrospective analysis was conducted on the clinical data of 86 patients with early-stage lung cancer admitted to our hospital between March 2020 and February 2025. All patients underwent MSCT examination. Using pathological examination as the gold standard, the consistency between MSCT and the gold standard was analyzed. CT sign differences among patients with different pathological types of lung cancer were compared. Pearson correlation analysis was used to analyze the relationships between CT signs and the degree of adenocarcinoma infiltration. Results MSCT examination showed positive findings in 75 cases of adenocarcinoma, with a sensitivity of 97.40%, a specificity of 88.89%, a positive predictive value of 98.68%, a negative predictive value of 80.00%, an accuracy of 96.51%, and a Kappa value of 0.823. Significant differences were found in the proportions of tumor maximum diameter > 2 cm, vacuole sign, ground-glass opacity sign, lobulation sign, spiculation sign, air bronchogram sign, pleural indentation sign, and vascular convergence sign (P<0.05), and these proportions increased progressively from carcinoma in situ to minimally invasive adenocarcinoma to invasive adenocarcinoma. Pearson correlation analysis showed that tumor maximum diameter, vacuole sign, ground-glass opacity sign, and pleural indentation sign were positively correlated with adenocarcinoma, while spiculation sign and vascular convergence sign were negatively correlated with adenocarcinoma (P<0.05). Conclusion MSCT demonstrates high diagnostic efficiency for early-stage lung adenocarcinoma and can provide a reference for early clinical evaluation.

ObjectiveTo investigate the changes and effects of fatty acid metabolism in folic acid （FA）-induced kidney injury and diabetic nephropathy （DN） mouse models. MethodsThe FA-induced kidney injury model was established via intraperitoneal injection of FA. Nine adult C57BL/6J mice were randomly allocated to two groups： saline control group （Saline， n=5） and FA intervention group （n=4）. Mice in the FA group received a single intraperitoneal injection of FA （250 mg/kg）， whereas those in the Saline group were administered an equivalent volume of normal saline. The DN model was constructed using a high-fat diet combined with streptozotocin （STZ） injection. Eleven adult C57BL/6J mice were randomly divided into two groups： normal diet control group （ND， n=6） and DN model group （DN， n=5）. The ND group was fed a normal diet throughout the experiment； the DN group was maintained on a high-fat diet for 8 weeks， followed by a single intraperitoneal injection of STZ （100 mg/kg）， and then continued on the high-fat diet until week 16. （1） Hematoxylin and eosin （HE） and sirius red staining were used to observe pathological changes in the kidneys of the four groups of mice. （2） RNA-Seq was performed on mouse kidney tissues to screen for differentially expressed genes （DEGs）， followed by Gene Ontology （GO）， Kyoto Encyclopedia of Genes and Genomes （KEGG）， and Gene Set Enrichment Analysis （GSEA）. RT-qPCR was used to detect the mRNA levels of fatty acid synthesis and fibrosis-related genes. Lipid droplet accumulation was assessed by Oil Red O staining on frozen kidney sections. （3） Human renal cortical proximal tubular epithelial cells （HK-2） and proximal tubular epithelial cells （PTECs） were treated with 10 ng/mL recombinant human TGF-β1 or high glucose. RT-qPCR was used to measure the mRNA levels of fatty acid synthesis and fibrosis-related genes in HK-2 cells. Lipid droplet accumulation in HK-2 cells and PTECs was detected using Bodipy 493/503 staining. （4） HK-2 cells were treated with 100 µmol/L palmitic acid （PA）. Bodipy 493/503 staining was used to evaluate lipid droplet accumulation. （5） SA-β-gal staining was used to assess senescence in kidney tissues from all four mouse groups. Cellular senescence and the expression of senescence-associated secretory phenotype （SASP） factors in PA-treated HK-2 cells were assessed using SA-β-gal staining， Western blot， and RT-qPCR. The effect of PA-treated PTECs on renal fibroblast activation was assessed by immunofluorescence. Results（1） Both FA and DN groups showed pathological changes in kidney tissue， including renal tubular structural damage and collagen fiber deposition. （2） DEGs in both FA and DN groups were significantly enriched in metabolism-related pathways， especially lipid metabolism pathways. Compared to the Saline control， the expression of fatty acid synthesis genes Srebp1 and Fasn was significantly upregulated in the FA group （Srebp1： t=2.445， P=0.044 4； Fasn： t=2.571， P=0.037 0）. Compared to the ND group， Srebp1， Acc1， and Fasn gene expression was upregulated in the DN group （Srebp1： t=3.354， P=0.010 0； Acc1： t=2.602， P=0.031 5； Fasn： t=2.358， P=0.046 1）. The fibrosis-related gene Col1a1 was also upregulated in both FA and DN groups （FA： t=2.628， P=0.034 0； DN： t=3.602， P=0.007 0）， accompanied by pathological signs of lipid accumulation. （3） In HK-2 cells treated with TGF-β1 or high glucose， the mRNA expression levels of SREBP1 （F=15.41， P=0.004 3； TGFβ： P=0.002 9； HG： P=0.045 2）， ACC1 （F=30.30， P=0.000 7； HG： P=0.001 4）， and FASN （F=18.76， P=0.002 6； TGFβ： P=0.001 7； HG： P=0.031 0） were significantly upregulated. Both treatments also induced lipid accumulation in HK-2 cells and PTECs. （4） There was an increase in senescent cells in the kidneys of both the FA and DN groups. PA treatment induced lipid accumulation， accelerated senescence， and activated fibroblasts in renal tubular epithelial cells. ConclusionsTranscriptional abnormalities of lipid metabolism-related genes were observed in the kidneys of both FA-induced kidney injury and diabetic nephropathy models. Excessive fatty acid synthesis leads to lipid accumulation， which induces senescence in PTECs and ultimately promotes the development and progression of fibrosis.

Objective:To explore the efficacy and its related factors of rituximab (RTX) in the treatment of children with frequently relapsing nephrotic syndrome/steroid-dependent nephrotic syndrome (FRNS/SDNS).Methods:It was a single-center retrospective study. The clinical data of FRNS/SDNS children first treated with RTX in the First Affiliated Hospital of Sun Yat-sen University from November 1, 2016 to September 1, 2023 were collected. The number of relapse within 1 year before and after RTX treatment, the time to first relapse after RTX treatment, and the time to B-cell reconstitution were analyzed. At the first treatment, a single dose of RTX was given at 375 mg/m 2, with a maximum dose of 500 mg, once a week, for 1 to 4 doses. The count of CD19 + lymphocytes in the peripheral blood of the children was continuously monitored. If B-cell reconstruction was performed, the decision on whether to proceed to the next course of RTX treatment was made based on clinical manifestations. Kaplan-Meier method was used to analyze relapse-free survival rate after receiving RTX. Cox proportional hazards regression model was used to analyze the related factors of relapse after RTX treatment. Results:A total of 98 FRNS/SDNS children receiving RTX treatment were enrolled, including 75 males (76.5%). The age at onset was 4.0 (1.9, 7.1) years and age of receiving RTX was 11.3 (8.5, 13.5) years. There were 90 children (91.8%) achieving complete remission, while 8 patients (8.2%) did not respond to RTX treatment, and 3 patients (3.1%) progressed to end-stage kidney disease after receiving RTX. The relapse-free survival rates at 6 months and 1 year after RTX treatment were 83.3% (75/90) and 57.9% (22/38), respectively. The frequency of relapse 1 year after RTX treatment decreased compared to 1 year before RTX treatment ( Z=-7.398, P<0.001). Compared with children without relapse during the period of B-cell depletion, relapsed children had a higher number of relapse within one year after RTX treatment ( Z=5.246, P<0.001). The time to first relapse after RTX treatment was 8.3 (4.6, 13.9) months in 51 relapse patients. Compared with children receiving 1 dose of RTX in the first course, those receiving 2 or more doses had a longer time to the first relapse ( Z=2.983, P=0.003). There was no statistically significant difference in time to the first relapse between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). The reconstruction time of B cells after the first course of RTX was 6.9 (5.3, 9.0) months. Compared to children receiving one dose of RTX in the first course, those receiving two or more doses had a longer B-cell reconstitution time ( Z=2.739, P=0.006). There was no statistically significant difference in B-cell reconstitution time between children who received mycophenolate mofetil therapy after RTX treatment and those who didn't ( P>0.05). Univariate Cox regression analysis showed that recurrence after calcineurin inhibitor (CNI) treatment before RTX treatment and the number of recurrence in one year before RTX treatment were correlated factors of recurrence after RTX treatment (both P<0.05). Multivariate Cox regression analysis showed that recurrence after CNI treatment before RTX treatment was an independent correlated factor of relapse after RTX therapy ( HR=3.496, 95% CI 1.245-9.818, P=0.018). Infusion reactions occurred in 10 patients (10.2%) and infections were observed in 24 patients (24.5%) during B cell depletion. No serious adverse events occurred. Conclusions:RTX is well tolerated and effective in treating FRNS/SDNS. Recurrence after CNI treatment before RTX treatment may be an independent related factor of relapse after RTX treatment.

Objective To construct and verify a risk prediction model of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and to screen the optimal model by using machine learning algorithm,so as to provide references for clinical formulation of a nursing risk management plan.Methods The convenience sampling method was used to retrospectively select 476 patients who underwent thoracoscopic radical resection of lung cancer in a tertiary hospital in Hangzhou,Zhejiang Province from January to December 2023 as a construction group.Logistic regression,decision tree,random forest and naive Bayesian model were constructed by SPSS 29.0 and R 4.3.0 software.The prediction performance of each model was compared by accuracy,precision,recall,F1 score and area under the receiver operating characteristic curve,and the optimal model was screened.From January to June 2024,204 patients in the unit were prospectively selected as the research subjects of an external validation group.The discrimination and calibration of the optimal model were evaluated by AUC value and calibration curve.Results A total of 680 patients completed the survey.All 4 models showed that multimodal analgesia,thoracic drainage tube type,pain score,tracheal intubation type,state anxiety and catheter indwelling time were the influencing factors of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer(P＜0.05).The 4 risk prediction models showed that the random forest prediction model had the best comprehensive performance.The external verification results showed that the AUC value was 0.913,and the calibration curve fitted well with the 45° ideal line.Conclusion Among the 4 risk prediction models,the random forest prediction model has the best performance,which is more suitable for the assessment of the risk of emergence agitation in patients undergoing thoracoscopic radical resection of lung cancer,and has good generalization and clinical application value.

Objective:To investigate the risk factors for kidney injury during anti-retroviral therapy (ART) with zidovudine (AZT) or tenofovir disoproxil fumarate (TDF) in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients, and to construct and validate a prediction model for the risk of kidney injury in HIV/AIDS patients based on a nomogram.Methods:A total of 923 HIV/AIDS patients admitted to Liuzhou People′s Hospital between January 1st, 2004 and December 31st, 2020 were included in this study. The modeling set (647 cases) and the validation set (276 cases) were divided in a 7∶3 ratio. Risk factors were screened using the least absolute shrinkage and selection operator (LASSO) regression analysis, and a nomogram prediction model for renal impairment risk in HIV/AIDS patients was constructed based on the selected variables. The model′s predictive performance was assessed by calculating the area under the curve (AUC) using the receiver operating characteristics curve (ROC curve). The performance of this model was evaluated using calibration curves. The clinical utility of the model was assessed using decision curve analysis (DCA).Results:Among 923 HIV/AIDS patients, there were 91 cases with kidney injury, including 67 in the modeling set and 24 in the validation set. AZT was used in 29 cases, and TDF was used in 62 cases. LASSO regression analysis was employed to screen seven non-zero variables, including age, ART regimen, baseline estimated glomerular filtration rate (eGFR), baseline CD4 + T lymphocyte count, baseline human immunodeficiency virus (HIV) RNA, baseline hemoglobin, and baseline aspartate aminotransferase (AST), their LASSO regression coefficient were 1.296, 0.250, 1.443, 0.240, 0.120, 0.395, and 0.002, respectively. Based on these variables, a visual nomogram model was constructed and subsequently validated. Through ROC curve analysis, the AUC for the modeling set was 0.826 (95% confidence interval ( CI) 0.767 to 0.884), with a sensitivity of 0.731 and a specificity of 0.809. For the validation set, the AUC was 0.872 (95% CI 0.807 to 0.956), with a sensitivity of 0.875 and a specificity of 0.778. The calibration curve results for the modeling set showed a mean absolute error (MAE) of 0.012 and a consistency index of 0.826, while the validation set had an MAE of 0.021 and a consistency index of 0.872. These results indicated that the model had a high goodness-of-fit, excellent calibration performance, and was reliable and stable. When the risk threshold for the modeling set ranged from 2% to 73%, the model demonstrated favorable net benefits, indicating its excellent clinical utility. Conclusion:The nomogram-based risk prediction model for kidney injury in HIV/AIDS patients is constructed using seven variables including age, ART regimen, baseline eGFR, baseline CD4 + T lymphocyte count, baseline HIV RNA, baseline hemoglobin, and baseline AST, which provides a valuable tool for early identification of individuals at risk of kidney injury and supports timely clinical interventions.

IgA nephropathy（IgAN）is the most common primary glomerular disease，characterized by the deposition of IgA in the glomerular mesangial area. IgAN is a progressive disease with a protracted and relapsing course. Approximately 50%~75% of adult IgAN patients experience renal function deterioration and eventually progress to end-stage kidney disease（ESKD）within 20 years after diagnosis. Among patients with onset in childhood，about 30% ultimately progress to ESKD after 20 years of long-term follow-up. In recent years，numerous studies have continuously explored important signaling pathways and key molecules in its pathogenesis. This review introduces the therapeutic advances in IgAN，aiming to provide better treatment options for clinicians.

BACKGROUND:At present,modern medical treatment has certain limitations on the treatment of knee osteoarthritis.Traditional Chinese medicine alkaloids can effectively prevent and treat knee osteoarthritis through various mechanisms. OBJECTIVE:To review the mechanism of alkaloids in traditional Chinese medicine in the prevention and treatment of knee osteoarthritis,providing a scientific basis for the clinical development of drugs for the treatment of knee osteoarthritis. METHODS:CNKI,WanFang,PubMed,Web of Science and Google Scholar were retrieved for relevant literature published from database inception to May 2024.The key words were"knee osteoarthritis""osteoarthritis""osteoclast""chondrocyte""alkaloids"in Chinese and English.Duplicates and obsolete non-referenced literature were excluded,and a total of 68 eligible papers were included for further review. RESULTS AND CONCLUSION:Although traditional Chinese medicine has a long history of treating knee osteoarthritis,only a small number of natural compounds are in the preclinical stage of research against knee osteoarthritis.Alkaloids have a greater potential for the prevention and treatment of knee osteoarthritis,among which,sophocarpidine,oxymatrine,sinomenine,and betaine have been shown to be effective in the prevention and treatment of knee osteoarthritis by modulating multiple signaling pathways.Alkaloids can delay the progression of knee osteoarthritis by inhibiting inflammatory response,exerting antioxidant response,inhibiting chondrocyte apoptosis,promoting chondrocyte proliferation,and inhibiting osteoclast formation and differentiation.

Objective:To systematically analyze the revisions content and technological development trends of microbiological standards in the Chinese Pharmacopoeia(ChP)2025 Edition,and explore its novel requirements in risk-based pharmaceutical product lifecycle management.Methods:A comprehensive review was conducted on 26 microbiological-related standards to summarize the revision directions and scientific implications from perspectives including the revision overview,international harmonization of microbiological standards,risk-based quality man-agement system,and novel tools and methods with Chinese characteristics.Results:The ChP 2025 edition demon-strates three prominent features in microbiological-related standards:enhanced international harmonization,intro-duced emerging molecular biological technologies,and established a risk-based microbiological quality control sys-tem.Conclusion:The new edition of the Pharmacopoeia has systematically constructed a microbiological standard system,which significantly improves the scientificity,standardization and applicability of the standards,providing a crucial support for advancing the microbiological quality control in pharmaceutical industries of China.

Objective: To systematically analyze the revisions content and technological development trends of microbiological standards in the Chinese Pharmacopoeia (ChP) 2025 Edition, and explore its novel requirements in risk-based pharmaceutical product lifecycle management.
Methods: A comprehensive review was conducted on 26 microbiological-related standards to summarize the revision directions and scientific implications from perspectives including the revision overview, international harmonization of microbiological standards, risk-based quality management system, and novel tools and methods with Chinese characteristics.
Results: The ChP 2025 edition demonstrates three prominent features in microbiological-related standards: enhanced international harmonization, introduced emerging molecular biological technologies, and established a risk-based microbiological quality control system.
Conclusion: The new edition of the Pharmacopoeia has systematically constructed a microbiological standard system, which significantly improves the scientificity, standardization and applicability of the standards, providing a crucial support for advancing the microbiological quality control in pharmaceutical industries of China.

Objective To establish a method for simultaneous determination of trace levels of microcystins,cylindrospermopsin,anatoxin,and nodularin in lake water based on liquid chromatography-tandem mass spectrometry(LC-MS/MS).Methods After being adjusted to alkaline conditions and mixed with six internal standards,the water samples were enriched using dual HLB and ENVI-Carb cartridges.The eluates were then evaporated under nitrogen,reconstituted,and subjected to instrumental analysis.Both water and acetonitrile containing 0.1%formic acid were used as mobile phases.An ACQUITY UPLC? BEH C18 column(150 mm×2.1 mm,1.7 μm)was selected to separate the target cyanotoxins.Multiple reaction monitoring was applied for data acquisition,and quantification was accomplished using internal standard methods.Results Within certain concentration ranges,all 14 cyanotoxins examined in the study showed good linearity,with all correlation coefficients greater than 0.998.When the water volume was 100 mL,the limits of detection and quantification for the 14 cyanotoxins were 0.1-0.9 ng/L and 0.3-2.9 ng/L,respectively,and spiked recoveries and relative standard deviations were 81.7%-132.9%and 1.2%-14.9%,respectively.In the 10 lake water samples analyzed,cylindrospermopsin,anatoxin-α,and multiple microcystins were detected.Conclusion The method developed in the study has high-throughput capacity,as well as high sensitivity,accuracy,and reliability.The method can be applied in the simultaneous detection of microcystins,cylindrospermopsin,anatoxin,and nodularin in lake water.